Love, caring and a child's smile

An interview with pediatric surgeon, M.D. Zoran Barčot

20 NOVEMBER 2016,
The Children's Hospital in Zagreb - A view from the operational room
The Children's Hospital in Zagreb - A view from the operational room

Children’s Hospital Zagreb is a central and unique care institution for treating children and adolescents in the Republic of Croatia. Architecturally, it is an interesting whole made up of four buildings from different eras, from the Art Nouveau 'Fisher' building, the oldest of the four, which dominates the hospital's landscape with its beauty, to the 'Turin' building, an award winning building of modern Croatian architecture, to the contemporary court-yard building. In medical terms, it is a modern European hospital built on the strong foundations of long-time tradition and experience. I have a great opportunity to talk to Mr Zoran Barčot, very successful pediatric surgeon.

Can you please describe the success of the Children's Hospital in Zagreb, how it is organised and how does it work?

The quality of medical care, the quick treatment of patients and shorter hospital stays are the main goals of our work today. In the last twenty years, despite the war and unstable economy, we have introduced the most sophisticated methods and technology into our surgical procedures, and the average hospital stay has been reduced from ten days to just over 6, with a tendency to further decrease. With more than 13500 m² of space, 650 professionals and 205 beds, we have over 11.500 in-hospital patients and conduct more than a million medical procedures per year. We have more than 230.000 patients coming through the outpatient clinic each year. From these statistics we can conclude that the values of our hospital are based not only on knowledge, expertise and quality, but also love, caring and a child's smile.

Pediatric Surgery Department plays one of the main roles in the Children's Hospital. 23 specialists in six divisions, conducting more than 6000 relevant surgical procedures per year, offer full surgical care and treatment for their patients. Endoscopic, laparoscopic and laser procedures are carried out daily. The Pediatric Surgery Department is also an educational base for the University of Zagreb School of Medicine. Passing on our knowledge and experience to students and young doctors is important to us, and, for years, our courses have been rated among the best by anonymous student surveys.

Children's Hospital Zagreb is an incredibly successful hospital even in global terms. What would you especially highlight?

Knowledge, expertise and quality medical services are what our hospital values are based upon: a full approach to the patient, and teamwork. A holistic approach requires understanding the child as a whole, inseparable unit, not treating only the disease, but the whole child. Teamwork requires cooperation on all levels and in all directions, not just within the hospital but also with other institutions in Croatia, Europe and abroad. Under the motto 'All for the child under one roof', driven by the principles of integrated pediatric medicine, with the help of many cooperating institutions and top experts from other medical institutions, and in accordance with the International Convention on the Rights of the Child, we are raising the quality and scope of our services. We always want the child to remain in the best possible surroundings – the Children's Hospital – meaning that we bring the experts to the child. This does not only include those from Croatia but top global experts as well. In the last twenty years, we have had more than twenty multidisciplinary surgical teams from some of the best pediatric hospitals in the USA, Sweden, Switzerland, Germany, France, Great Britain, and others, working under our roof with our medical teams.

Working daily with young patients must surely be a sensitive job, full of professional challenges. In what way do you establish a connection with children? Do you have a 'secret method'?

Successful communication with children is an important factor in psychosocial development, and a significant factor in the treatment process. Verbal communication and the style of expression depends on age, and sometimes requires slang and phrases in order to establish a stronger and more advance communication with the child. Non-verbal communication such as tone, nodding in approval, eye contact, and the readiness to adapt and agree, are often key to gaining their trust.

What are the challenges you meet every day?

Pediatric Surgeons are specially trained physicians with extensive experience and the greatest expertise in treating infants and children of all ages (from the neonatal period through adolescence) with surgical disorders. Because of their unique training pediatric surgical specialists provide a wide range of treatment options and the highest quality care to children. Awareness of the problems of pediatric hospital treatment is significantly greater than in the not-so-distant past. Today, pediatric units are open to parents, mothers are now able to stay full-time with their young children. Experience has shown that a parent's presence aids in the child's adjustment to both the illness and the treatment. The hospital also has a kindergarten and a school, and a programme offering spiritual guidance to both children and parents has also been initiated. The humanisation of hospital treatment, recognising and considering the needs of both the patient and the parents, along with systematic and organised improvements in communication, has become a daily process.

Love, caring and a child's smile are essential to treatment; they, too, are a form of 'medicine'. In developing awareness of a hospitalised child and his or her specific needs we are following global trends in adapting pediatric hospitals to young patients. Through continuous effort to secure the technological and material conditions for treatment, the humanisation of the hospital is an equally important goal. Through a series of local and international projects like 'The Hospital is a Child's Friend' and 'A Child's Smile', we continuously strive to keep up with the standards of modern pediatric hospitals.

Tell us about community involvement in the Children's Hospital?

The community is aware of our everyday problems, but is not readily available to offer significant, concrete help. Occasional donations, humanitarian concerts, participating in the supply of hospital equipment and the acquisition of medical instruments from both individuals and companies is not enough to meet the needs of our hospital. We have been trying, for more than a decade, to build a new, national pediatric hospital which would meet the standards of quality pediatric care.

You've been very successful in the treatment and rehabilitation of burns. What is key, what are you most proud of?

Division of Burns, Plastic and Reconstructive surgery is a part of the Reference Network of the Ministry of Health of the Republic of Croatia. Burns are one of the most severe injuries in children and require multidisciplinary teamwork. The Children's Hospital has the only Burns Unit in Croatia that offers young burn victims, and accompanying ailments, all-inclusive treatment, rehabilitation and care of both functional and aesthetic complications. Throughout the year, the emergency and specialist clinics register around 400 burn victims of which approximately 80 are admitted for in-hospital treatment. We have been successful at treating some of the most severe burns requiring skin grafts, keratinocytes or artificial skin. A report from the World Health Organisation on the prevention of burns in children showed that Croatia has the second lowest mortality rate among young burn victims within 38 European countries, with Switzerland having the lowest. Switzerland has begun an initiative to register our Burn Unit into a group of five Reference European Centres for the education and treatment of burns in young patients. We are proud of the fact that in the last twenty years all children with burns that have come through our Clinic within 72 hours of the incident have been successfully treated, regardless of the severity of the burns.

Diagnosis and treatment technology is increasingly present in medicine today. What can we expect in the next 10-15 years? Microsoft has announced revolutionary changes. How possible are they and where do you see pediatric medicine and surgery in the future?

Tissue engineering and regenerative medicine in the field of biotechnology will develop biological substitutes to replace lost tissue or organs. The demand for tissue-engineered organs is enormous and this technology holds the promise to supply customized organs to overcome the severe shortages that are currently faced by the pediatric patient, especially due to organ-size mismatch. Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. Companies like Microsoft with powerful and intelligent cloud platforms can enable our digital transformation, helping us better engage our patients, empower our care teams, optimize our clinical and operational effectiveness, and transform the care continuum for hospitals making individuals and communities around the world healthier.

If you could choose again, would it be pediatric surgery? What makes it so appealing to you?

Pediatric surgery will always be number one. I don't view it as just a job. It is my choice, my calling, my path, intertwined in an incredible number of ways with all of many remarkable achievements. As a doctor, sacrificing and always available, I am ready to give my absolute all for my patient.

Besides pediatric surgery, are there any other activities you partake in, both medical and otherwise?

I am a member of several international surgical and burn organisations in Europe and the world, I am a national delegate in the Mediterranean Network, I am active in the anti-doping movement (I was on the committee of the World Anti-Doping Agency for three years and am one of the founders of the Croatian Anti-Doping Agency), I have a postgraduate degree in Leadership and Management in Health Systems, and for more than 20 years I have been a physician for both the Croatian national basketball team and the Cibona basketball team in Zagreb, I am a Croatian war veteran and a member of the 1990/1991 Homeland War Veteran Physicians Association.

With such a challenging job how do you find time for yourself, deal with stress?

This year will be forty years that I have been an active basketball player, from my time as a first division player in Split, where I was born, to the recreational player I am today, still winning games and tournaments. I make time in my schedule to play once or twice a week with my veteran basketball player teammates. But by far my family offers me the greatest happiness and fulfilment. My 6 year-old Katja, 16 year-old Matea and my wife Lidija, master of nursing who is full of understanding of the job that I do, all equally enjoy the moments we spend relaxing together.